Gib Marcelo Curcio, Alvarez Juglans Souto, Wender Orlando Carlos Belmonte
Cardiovascular Surgery Department of Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
Rev Bras Cir Cardiovasc. 2013 Jun;28(2):200-7. doi: 10.5935/1678-9741.20130029.
This study aims to compare hospital mortality rate of surgical debridement followed by primary wound closure versus surgical debridement with closure after preconditioning of the wound.
A historical cohort of 43 patients with postoperative mediastinitis type III and IV between 2000 and 2008. The diagnosis of mediastinitis was based on physical examination and laboratory tests. Patients were divided into two groups: patients who received the protocol of preconditioning of the wound (Group 2) and those who did not (Group 1).
Of the 43 patients, 15 received the protocol and were assigned to Group 2, and 28 patients to Group 1. Myocardial revascularisation was the surgical intervention most affected by infection, accounting for 69.8% of patients in Group 1 and 64.3% in Group 2.Staphylococcus aureus was the predominant pathogen, accounting for 58.1% of all cases, 50% in Group 1 and 73.3% in Group 2. Hospital mortality rate was 42.9% in Group 1 and 20% in Group 2 (P=1.86), with relative risk of 2.14 and CI [0.714-6.043]. Among the 28 (65.1%) patients who underwent single-stage surgical approach, 12 (27.9%) underwent primary wound closure with irrigation, seven (16.3%) only primary closure, six (14%) omental flap, and three (7%) pectoralis muscle flap.
Due to the lack of established guidelines, the choice of the surgical approach is based largely on low-level evidence references. Preconditioning of the wound appears to lead to a reduction in mortality in these patients, being a good surgical option.
本研究旨在比较手术清创后一期伤口缝合与伤口预处理后手术清创并缝合的医院死亡率。
对2000年至2008年间43例III型和IV型术后纵隔炎患者进行回顾性队列研究。纵隔炎的诊断基于体格检查和实验室检查。患者分为两组：接受伤口预处理方案的患者（第2组）和未接受的患者（第1组）。
43例患者中，15例接受了该方案并被分配到第2组，28例患者被分配到第1组。心肌血运重建是受感染影响最大的手术干预，在第1组患者中占69.8%，在第2组中占64.3%。金黄色葡萄球菌是主要病原体，占所有病例的58.1%，在第1组中占50%，在第2组中占73.3%。第1组的医院死亡率为42.9%，第2组为20%（P = 1.86），相对风险为2.14，置信区间为[0.714 - 6.043]。在28例（65.1%）接受单阶段手术入路的患者中，12例（27.9%）进行了冲洗后一期伤口缝合，7例（16.3%）仅进行一期缝合，6例（14%）采用网膜瓣，3例（7%）采用胸大肌瓣。
由于缺乏既定指南，手术方法的选择很大程度上基于低水平证据参考。伤口预处理似乎能降低这些患者的死亡率，是一种较好的手术选择。
